Abstract W P261: Predictors of the Need for Intensive Care Unit Admission Following Supratentorial Intracerebral Hemorrhage
Background: Current guidelines recommend that initial management of patients with an intracerebral hemorrhage (ICH) occur in a neuroscience intensive care unit (ICU). However, some patients can be safely managed without ICU care. We evaluated factors that may predict the need for ICU level of care.
Methods: We reviewed the medical records of all adult patients with supratentorial ICH presenting within 72 hours of symptom onset seen from 2009-2012. Patients admitted for palliative care or ICH due to a known structural lesion were excluded. Criteria defining need for ICU level of care were: need for intubation/mechanical ventilation, hyperosmolar therapy, neurosurgical procedure, prolonged ICU admission, or significant clinical deterioration. A univariate and multivariable logistic regression analysis was performed on patient demographics, medical comorbidities, time to presentation, vital signs, GCS/FOUR score, medications, laboratory studies, and imaging to identify independent predictors of the need for ICU admission.
Results: 229 patients met inclusion criteria. Based on our triage criteria, 128 patients (56%) required ICU level of care. Multivariable analysis identified five factors that best predicted the need for ICU admission: younger age, shorter time to presentation, lower FOUR score, larger hemorrhage volume, and use of anticoagulants at presentation (table). Intraventricular hemorrhage and GCS score were not significant predictors on the multivariable analysis.
Conclusion: Age, time to presentation, FOUR score, hemorrhage volume, and use of anticoagulants predict the need for ICU care after ICH. These variables will be used to develop a formula to aid clinicians in appropriate initial triage of patients with ICH.
Author Disclosures: J. Klaas: None. S. Braksick: None. P. Kofronova: None. J. Mandrekar: None. A. Rabinstein: None. R.D. Brown: None.
- © 2014 by American Heart Association, Inc.